Purified vacuolating toxin from Helicobacter pylori and methods to use same

ABSTRACT

This invention relates to a purified Helicobacter pylori vacuolating toxin and methods to use this toxin to produce protective antibodies against H. pylori infection. Antiserum to this antigen can be used to detect the toxin. Methods to detect anti-toxin antibodies determine the susceptibility of a patient to develop peptic ulcer disease, gastric carcinoma, or other clinical consequences of H. pylori infection.

This application is a division of application Ser. No. 08/284,747 filed on Aug. 2, 1994, status pending, which is a filewrapper continuation of Ser. No. 07/841,644, filed Feb. 26, 1992, now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to a purified Helicobacter pylori vacuolating toxin, methods to use the purified toxin in diagnostic testing for the predisposition to peptic ulceration and gastric malignancy, and methods to use the purified toxin as a vaccine for providing immunologic protection against H. pylori infection.

2. Brief Description of the Background Art

Helicobacter pylori is a curved Gram-negative bacterium that is commonly present in the human stomach; once acquired, this organism persists for years or decades (Blaser, M. J. (1990) J. Infect. Dis. 161:626-633). Multiple lines of evidence now indicate that H. pylori infection nearly universally results in chronic gastritis (Dixon, M. F. (1991) J. Gastroenterol. and Hepatol. 6:125-130). Although most persons with H. pylori-induced gastritis remain asymptomatic, this condition is a significant risk factor for the development of both peptic ulceration and gastric adenocarcinoma (Peterson, W. L. (1991) N. Engl. J. Med. 324:1043-1048, and Nomura, A., Stemmermann, G. N., Chyou, P.-H., Kato, I., Perez-Perez, G. I, and Blaser, M. J., N. Eng. J. Med. 1991; 325:1132-6).

The pathogenesis of H. pylori infection is not yet well understood. The production of high levels of urease by the organism (Dunn, B. E., Campbell, G. P., Perez-Perez, G. I., and Blaser, M. J. (1990) J. Biol. Chem. 265:9464-9469), is thought to be essential for the initiation and maintenance of gastric infection (Eaton, K. A., Morgan, D. R., Krakowka, S. (1989) Infect. Immun. 57:1119-1125). Another potential virulence determinant is a toxin that induces vacuolation of eukaryotic cells (Cover, T. L., Halter, S. A., Blaser, M. J. (1992) Human Pathol. (in press)). Functionally active toxin is produced in vitro by 50-60% of H. pylori isolates (Leunk, R. D., Johnson, P. T., David, B. C., Kraft, W. G., and Morgan, D. R. (1988) J. Med. Microbiol. 26:93-99 and Cover, T. L., Dooley, C. P., and Blaser, M. J. Infect. Immun.; 58:603-610 (1990)). Antibodies that neutralize toxin activity are present in sera from H. pylori-infected persons, which indicates that the vacuolating toxin activity is relevant in vivo (Leunk, R. D., Ferguson, M. A., Morgan, D. R., Low, D. E., and Simor, A. E. (1990) J. Clin. Microbiol. 28:1181-1184 and Cover, T. L., Cao., P., and Blaser, M. J. (1991) Gastroentenology 100:A570). Two studies have indicated that the prevalence of infection with toxin-producing H. pylori is higher among H. pylori-infected persons with peptic ulceration than among infected persons with gastritis alone (Figura, N., Guglielmetti, P., Rossolini, A., Barberi, A., Cusi, G., Musmanno, R., Russi, M., and Quaranta, S. (1989) J. Clin. Microbiol. 27:225-226; Goosens, H., Vlaes, L., Lambert, J. P., Glupczynski, Y., Burette, A., and Butzler, J. P. (1991) Microb. Ecol. Health Dis. 4:S130).

In previous work, the inventors have identified several H. pylori proteins that are present in broth culture supernatants with vacuolating toxic activity, but absent or reduced in concentration in supernatants that lack toxic activity (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610). In addition, the inventors have demonstrated that the vacuolating toxin is distinct from H. pylori urease (Cover, T. L., Puryar, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). In this application the inventors describe the purification and characterization of the vacuolating toxin from H. pylori.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide a substantially pure antigenic composition with vacuolating toxin activity.

It is an object of the present invention to provide a purified antigenic composition that specifically binds antibodies to the toxin.

It is an object of the present invention to provide a clinical diagnostic test for the presence of infection with toxin-producing H. pylori, and thereby identify patients at risk for peptic ulcer disease or gastric malignancy.

It is an object of the invention to provide a protein vaccine which induces high levels of specific antibodies directed against H. pylori toxin, and which protects against natural H. pylori infection in humans.

It is another object of the invention to provide polyclonal or monoclonal antibodies specific for H. pylori toxin, and methods for their use in detecting the toxin, or for therapeutic purposes.

These and other embodiments are accomplished by providing the antigenic compositions, vaccines, methods, antisera or antibodies, and kits disclosed herein.

In one embodiment of the invention, a purified antigenic composition with vacuolating toxin activity (hereinafter termed CB antigen) is extracted from H. pylori broth culture supernatant, and has a molecular weight greater than 972,000 daltons (as determined by gel filtration chromatography under nondenaturing conditions), and an apparent molecular weight of 87,000±300 daltons when denatured (as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis under reducing conditions (SDS-PAGE). The term CB antigen is defined as the functionally active non-denatured vacuolating toxin; in contrast, the Mr=87,000 protein is a functionally inactive subunit of the CB antigen, which is detected only under denaturing conditions. The term CB antigen will include antigenic fragments of the holotoxin, whether derived from H. pylori or synthetically or recombinantly produced. Proteins having substantial homology to CB antigen or fragments thereof may also be used in accordance with the invention. Additionally, CB antigen analogs are also contemplated.

Antiserum or monoclonal antibodies raised against CB antigen may be used to test for the presence of toxin. Test samples are contacted with such antiserum, followed by detection of antibody binding to components of the test samples. Where such binding exceeds a predetermined positive threshold level, the sample is positive for toxin.

CB antigen may be capable of inducing protective immunity against H. pylori infection when administered to humans in a nonvirulent manner. Hence, the antigen may be used in combination with a suitable adjuvant, as a vaccine against future H. pylori infection.

In one aspect of the invention, CB antigen is used in methods for the detection of anti-toxin antibodies. The purified toxin is contacted with samples of body fluids suspected of containing antitoxin antibodies. Following such contacting, known methods are used to determine the extent of antigen-antibody complex formation. When formation of the complex exceeds a predetermined positive threshold value, the test is positive for presence of anti-toxin antibodies.

Preferred techniques for detecting formation of antigen-antibody complexes include, but are not limited to, enzyme-linked immunosorbent assay (ELISA), indirect imunofluorescence assay, latex agglutination, and liposome-based assay. Alternatively, a Western blot technique may be used, in which case the bands are detected by visual inspection, and substantial appearance of dark bands may be taken as a positive indication.

The extent of detection of the antigen/antibody complex which should be considered a positive signal (i.e., an indication that the test sample includes toxin-specific antibody) depends upon the detection means chosen, but may be defined generically as a value greater than the mean plus 1 interval of standard deviation from the results observed with samples from a negative control group, all other parameters (dilution of sample, time of incubation, etc.) being held constant. In some embodiments where higher specificity is desired, the mean plus two or mean plus three standard deviations may be utilized. The negative control group should consist of individuals who are known to be free of H. pylori infection.

In one aspect of the invention, kits are provided which include the antigenic compositions within the scope of the invention, and which further include means for detecting the presence of any immunoglobulin in a test sample which may become bound to antigens in said compositions.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1(A-C) shows column chromatography of H. pylori vacuolating toxin. Column eluates were monitored for absorbance at 280 nm (solid lines), and salt concentrations are indicated by the dashed lines. The vacuolating cytotoxin activity of fractions was assayed using the neutral red assay and is expressed as net optical density (solid circles). FIG. 1A) PHENYLSUPEROSE (Pharmacia) chromatography of ammonium sulfate-precipitated supernatant proteins. The presence of ammonium sulfate (0.5M) in the buffer of early fractions (volume 1-15 ml) contributed to the neutral red uptake induced by these fractions (Cover, T. L., Puryear, W., Perez-Perez, G. I., Blaser, M. J. (1991) Infect. Immun. 59:1264-70). FIG. 1B, the eluted peak from A was applied to a SUPEROSE 12 (Pharmacia) column, and toxic activity was detected in the void volume. FIG. 1C, fractions with toxic activity eluted from the SUPEROSE 12 (Pharmacia) column were applied to a MONO Q (Pharmacia) column, and toxic activity was eluted by a linear gradient of NaCl.

FIG. 2 shows sodium dodecyl sulfate-polyacrylamide gel electrophoresis (12% acrylamide) of H. pylori toxin (CB antigen) under denaturing, reducing conditions. Lanes are: a, proteins precipitated from a broth culture supernatant of H. pylori 60190 by a 50% saturated solution of ammonium sulfate; b, toxin partially purified by hydrophobic interactive chromatography; c, toxin partially purified by gel filtration chromatography; d, purified CB antigen after anion exchange chromatography, visualized as an Mr=87,000 band under denaturing, reducing conditions. Chromatography conditions were as described in the text. The migrations of marker proteins of known molecular weight (in kilodaltons) are shown at left.

FIG. 3 shows Western blot recognition of the Mr=87,000 protein band by immune rabbit serum. Proteins precipitated from the broth culture of H. pylori 60190 by a 50% saturated solution of ammonium sulfate were electrophoresed on a 10% acrylamide gel, transferred to a nitrocellulose paper, incubated with 1:10,000 dilutions of rabbit sera, and the antigens resolved. Lane a, preimmune serum. Lane b, antiserum produced against the purified denatured Mr=87,000 H. pylori protein subunit. The antiserum recognized only the Mr=87,000 band.

FIG. 4 shows neutralization of H. pylori vacuolating toxin activity by antiserum raised against the purified denatured Mr=87,000 protein subunit. Preimmune serum and antiserum raised against the purified Mr=87,000 H. pylori protein subunit were tested for toxin-neutralizing activity. The neutral red uptake induced by crude concentrated broth culture supernatant from H. pylori 60190 is indicated by the dashed line. At a dilution of 1:64, the antiserum completely neutralized toxin activity, whereas the preimmune serum failed to neutralize toxin activity.

FIG. 5 shows detection of the vacuolating toxin in H. pylori supernatants. Concentrated culture supernatants from 8 tox⁺ H. pylori strains and 8 tox⁻ strains were diluted 1:100 in carbonate buffer and tested in an ELISA for reactivity with antiserum to the denatured Mr=87,000 protein subunit (1:10,000 dilution). Tox⁺ supernatants produced significantly higher optical density values than tox⁻ supernatants (0.614±0.11 versus 0.046±0.01, p<0.0001).

FIG. 6 shows serologic recognition of the purified H. pylori toxin (CB antigen) by human sera. Sera from twenty H. pylori-infected persons and 20 uninfected persons were diluted 1:100 and tested in an ELISA for IgG reactivity with the purified CB antigen (15 ng/microtiter well). Sera from H. pylori-infected persons recognized the purified toxin significantly better than sera from uninfected persons (mean optical densities 0.424±0.06 and 0.182±0.02, respectively, p=0.0009).

DETAILED DESCRIPTION OF THE INVENTION AND BEST MODE

This work represents the first purification to homogeneity of the vacuolating toxin of H. pylori. The toxin was isolated from broth culture supernatant by ammonium sulfate precipitation, followed by hydrophobic interactive chromatography, gel filtration chromatography, and anion exchange chromatography. The term substantially pure means that the CB antigen is present in the antigenic composition at a concentration, relative to the other H. pylori products, higher than that in the H. pylori broth culture supernatant.

These procedures resulted in recovery of a purified, functionally active toxin, with molecular weight greater than 972,000 daltons under non-denaturing conditions (CB antigen). The purification of this protein was associated with a greater than 5000-fold increase in specific activity of the toxin. Analysis of the purified toxin (CB antigen) by SDS-PAGE under denaturing, reducing conditions demonstrated the presence of a single band migrating at 87,000 daltons. By ELISA, antiserum to the denatured Mr=87,000 protein subunit reacted with tox⁺ H. pylori supernatants to a significantly greater extent than with the tox⁻ H. pylori supernatants. In addition, antiserum to the denatured Mr=87,000 protein subunit neutralized the vacuolating toxic activity of H. pylori 60190, as well as the toxins produced by other H. pylori strains. Altogether, these data support the role of the CB antigen in vacuolating toxin activity, and indicate that the toxins produced by various H. pylori strains are antigenically related.

Western blot analysis demonstrated that the denatured Mr=87,000 protein subunit appears identical to a band identified in our previous analysis of tox⁺ H. pylori culture supernatants (originally reported as Mr=82,000) (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610). Our previous study of tox⁺ H. pylori supernatants also identified an Mr=128,000 protein, which was recognized by sera from patients with peptic ulceration more frequently than by H. pylori-infected persons without ulcer disease (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610; Crabtree, J. E., Taylor, J. D., Wyatt, J. I., Heatley, R. V., Shallcross, T. M., Tompkins, D. S., and Rathbone, B. J. (1991) Lancet 338:332-335). The current study indicates that the Mr=128,000 protein is not required for expression of vacuolating toxin activity, and is not immunologically cross-reactive with the Mr=87,000 protein subunit.

Any sample suspected of containing antibodies may be tested in accordance with the methods set forth herein. Preferably, the samples to be tested are bodily fluids such as blood, serum, urine, tears, saliva and the like. In addition to human samples, samples may be taken from mammals such as non-human primates, horses, swine, etc. Due to the sensitivity of the test described, it is possible to dilute the sample prior to testing. Dilution may proceed by addition of any fluid compatible with each of the sample, the antibodies to be tested, and the antigenic composition. Serum, when used as the sample, may, for example, be diluted with one or more fluids selected from the group consisting of phosphate-buffered saline, pH 7.0-7.4 (hereinafter, "PBS"), PBS-containing Tween 20 (hereinafter, "PBS T"); PBS T with thimerosal (hereinafter, "PBS" TT), PBS TT with gelatin (hereinafter, "PBS TTG"), and PBS TTG with bovine gamma globulin (hereinafter, "PBS TTGG"). Dilutions, when testing for IgG antibody, may be as high as a ratio from about 1:100 to about 1:1000. Although samples also may be tested for IgA and IgM antibodies, IgG tests are preferred.

Preferred diluents and dilution ratios may vary according to the sample being tested. Urine, for instance, is already relatively dilute and may not need to be diluted further. However, it may not be necessary to concentrate urine as is often necessary with other assays. Prior to testing, the pH of urine is preferably adjusted to between about 7.0 and 7.4, the preferred pH for antibody function.

While dilution of sample is not required, it is believed that dilution reduces the possibility that significant antigen/antibody complexes will be formed in the absence of H. pylori specific antibodies. The extent of dilution should be taken into account in adjusting the threshold level of antigen/antibody complex which should be considered a positive signal.

While the present disclosure provides an easy method for obtaining the purified toxin (CB antigen) from the deposited H. pylori strain, it is emphasized that this antigen is common to a number of H. pylori strains. While the deposited strain and the description of the present specification provide an easy manner of isolating this antigen, it is emphasized that the present invention broadly encompasses use of the antigen regardless of the source or method whereby it is derived.

Before contacting a test sample with antigenic compounds in accordance with the invention it is preferred (but not necessary) that the antigenic composition be immobilized using conventional techniques. In one alternative embodiment, liposome-based assays may be used as described in more detail below. For conventional immobilization, polystyrene plates, for example, may be incubated with antigenic suspensions made in accordance with the invention. Alternatively, for example, antigens isolated as protein bands on electrophoretic gel may be transferred to a nitrocellulose sheet by known methods. See Towbin et al., Proc. Nat'l. Acad. Sci., 76:4350-54 (1979); Burnette et al., Biochem., 112:95-203 (1981). Numerous other techniques are known in the art for binding antigens to substantially inert substrates.

Bound antigens in accordance with the invention are preferably contacted with a dilute fluid which includes the sample to be tested for presence of antibody to H. pylori. The antigen and sample are preferably incubated for at least 5 to 15 minutes. Less time is needed when incubation proceeds at or near human body temperature, about 37° C. Incubation at other temperatures, for instance 4° C., is also proper, but generally requires additionally incubation time. Preferred incubation time at 37° C. is from about 5 minutes to about 90 minutes. Rapid assays can also be performed at room temperature. The bound antigens should then be rinsed to remove any unbound antibodies, i.e., those which are not specific for the antigens. Preferably, rinsing proceeds with a buffer solution such as PBS T, PBS TT or Tris/Tween/Sodium chloride/azide. Multiple rinsings are preferred.

During incubation, H. pylori specific antibodies bind to the immobilized antigens to create antigen/antibody complexes. All unbound antibodies are substantially removed during the rinsing procedure. Due to the high specificity of the antigens of the invention, antibodies which are not specific for H. pylori are substantially removed by the rinsing. Naturally, if the tested sample did not contain H. pylori specific antibodies, the immobilized antigens would be substantially free of human antibody, and subsequent testing for antigen/antibody complexes should not indicate a substantial presence of such complexes. On the other hand, if the tested sample were rich in H. pylori specific antibodies, these antibodies should have bound to the immobilized antigens to form a large quantity of antigen/antibody complex for subsequent detection.

Detection of antigen/antibody complex may be achieved by a wide variety of known methods. Preferred methods include but are not limited to enzyme-linked immunosorbent assay, latex agglutination, Western blot technique or indirect immunofluorescence assay.

Typically, the H. pylori specific antibodies complexed with immobilized antigen are detected by contact with labeled or otherwise detectable second antibodies specific for the immunoglobulin being tested for. If the test sample is human sera, for example, the detectable second antibody is specific for human immunoglobulin. The labeled second antibodies may be specific for any human antibody, preferably of the IgG or IgA type, most preferably IgG. When acute sero-conversion is suspected, an IgM test using a labeled second antibody specific for IgM may be appropriate. The second antibodies are preferably incubated with the immobilized antigens for about 5 minutes to about 2 hours, preferably 30 minutes to 60 minutes at a temperature of about 20° C. to about 37° C. Then, the antigens are washed with a buffer solution (preferably multiple times) in order to remove all unbound labeled antibody. The washings will remove substantially all labeled antibody except that which has bound to immunoglobulin present on the antigens. Of course, substantially the only human immunoglobulin present at this point should be H. pylori specific antibody. Hence, the presence of H. pylori specific antibody may be indirectly measured by determining the presence or absence of the labeled second antibody.

There are many known techniques for detecting the label, which vary with the type of label used. For instance, fluorescein-labeled antibody may be detected by scanning for emitted light at the characteristic wavelength for fluorescein. Alternatively, an enzyme label is detected by incubation with appropriate substrates and detection of an enzyme activity, preferably activity resulting in a color change. Such activity can be determined by visual inspection or can be read automatically by a spectrophotometer set at the appropriate wavelength.

Alternatively, the enzyme label may be horseradish peroxidase and the substrate may be H₂ O₂ and 2,2'-azinobis(3-etylbenzothiazoline-6-sulfonic acid) which produces in the presence of the enzyme, a compound detectable by a spectrophotometer set at 414 nm.

In Western blotting, the positive signal may be detected when an enzyme is conjugated to the second antibody. Incubation with appropriate substrate enzymatically produces a color product in the immediate vicinity of the antigenic band resolved by this process. The presence of a reactive band may be detected by visual inspection. In an indirect immunofluorescence assay, fluorescein-labeled second antibodies may be detected by flurorescence-activated detectors, or by visual inspection.

A liposome-based assay may involve the presence of fluorescein, an enzyme or a substrate inside a liposome onto whose surface H. pylori antigens are expressed. These liposomes are incubated with a diluted body fluid sample to be tested, and are thoroughly washed. Any liposome with immunoglobulins on their surface forming an antigen/antibody complex may be recognized by attaching a second antibody, specific to the imunoglobulin being tested for, onto the inside walls of a polystyrene tube containing the liposomes. Liposomes having antibody bound to their surfaces will become immobilized on the tube walls, and non-immobilized liposomes will be washed away. The liposomes can by lysed with, for instance, detergent, or complement, and the enzyme or substrate that was in the interior is now free to react with the complementary substrate (or enzyme) in the solution in the tube. Enzymatic activity, preferably a color change reaction could be detected by visual inspection or spectrophotometric color determination. Enzymatic activity beyond the predetermined positive threshold indicates the presence of H. pylori specific antibodies.

The sensitivity and specificity of the antibody detection in accordance with the present invention have been determined using serum obtained from persons from defined populations. By ELISA, IgG antibodies to the purified toxin (CB antigen) have been identified in sera from H. pylori-infected persons. The ELISA optical density values produced by sera from approximately 50% of H. pylori-infected persons exceeded the range produced by sera from uninfected persons. This suggests that approximately 50% of H. pylori-infected persons are infected with strains of H. pylori that produce the toxin. Similarly, approximately 50% of H. pylori strains produce the toxin in vitro. (Leunk, R. D., Johnson, P. T., David, B. C., Kraft, W. G., and Morgan, D. R. (1988) J. Med. Microbiol. 26:93-99; Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610).

In this application results are expressed as the mean±SEM. Optical density values were compared using the two-tailed Student's t test for independent variables.

EXAMPLE 1 Purification of Toxin

H. pylori 60190 (ATCC 49503), a previously described toxin-producing strain, was used as the source for toxin purification. H. pylori 60190 was cultured for 48 hours at 37° C. in Brucella broth containing 0.5% charcoal (untreated, granular 8-20 mesh, Sigma) in an ambient atmosphere containing 5% CO₂ (Cover, T. L., Puryear, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). The culture was centrifuged at 10,000 g for 20 minutes, and proteins present in the supernatant were precipitated with a 50% saturated solution of ammonium sulfate. After centrifugation at 10,000 g for 15 minutes, the pellet was resuspended in 60 mM Tris-HCl (pH 7.7).

Hydrophobic interactive chromatography was performed on a PHENYLSUPEROSE HR 5/5 column (Pharmacia LKB Biotechnology Inc., Piscataway, N.J.) with buffer containing 60 mM Tris-HCl and 0.5M ammonium sulfate (pH 7.7), and proteins were eluted with 60 mM Tris HCl (pH 7.7). Size exclusion chromatography was performed on a SUPEROSE 12 HR 16/50 column (Pharmacia) with buffer containing 60 mM Tris-HCl and 0.1M NaCl (pH 7.7) at a flow rate of 0.12 ml/min. Anion exchange chromatography was performed on a MONO-Q HR 5/5 column (Pharmacia) in 20 mM Tris (pH 7.7). Proteins were eluted with 20 mM Tris containing a linear gradient of 0.3M NaCl to 0.6M NaCl over 10 ml. Column eluates were monitored for UV absorbance at 280 nm.

HeLa cells were cultured in Eagle's modified minimal essential medium containing 10% fetal bovine serum (MEM-FBS) in 96-well plates, as previously described (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610). Toxin preparations were serially diluted in MEM-FBS, and 10 μl aliquots were incubated with adherent cells and 90 μl of medium in 96-well plates for 18 hours at 37° C. Cell vacuolation was then quantitated spectrophotometrically using a neutral red uptake assay, as previously described (Cover, T. L., Puryear, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). The titer of toxic activity in a sample was defined as the maximum dilution of the sample that produced an optical density value greater than or equal to three SD above that produced by medium alone. The specific activity of a sample was defined as the ratio of the reciprocal toxin titer to the protein concentration (in mg/ml). For determination of specific activity, MEM-FBS was supplemented with ammonium chloride (10 mM), a concentration previously shown to potentiate toxic activity (Cover, T. L., Puryear, w., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270), and which approximates the concentration of ammonium ion in the gastric juice of H. pylori-infected humans (Marshall, B. J., and Langton, S. R. (1986) Lancet i:965-966).

Protein concentrations were measured using either QUANTIGOLD reagent (Diversified Biotech, Newton Centre, Mass.) or the BCA protein assay reagent kit (Pierce, Rockford, Ill.), depending on the concentration of samples, and albumin was used as a standard. SDS-PAGE was performed in a modified Laemmli gel system as described by Ames (Ames, G. F. -L (1974) J. Biol. Chem 249:634-644), and proteins were resolved in gels using the silver stain of Oakley et al. (Oakley, B. R., Kirch, D. R., and Morris, N. R. (1980) Anal. Biochem. 105:361-363). Molecular weight standards included rabbit muscle phosphorylase b (97,400), bovine serum albumin (66,200), hen egg white ovalbumin (45,000), bovine carbonic anhydrase (31,000), and soybean trypsin inhibitor (21,500) (Biorad, Richmond, Calif.).

The purification of the vacuolating toxin of H. pylori involved ammonium sulfate precipitation of proteins present in broth culture supernatant, followed by sequential hydrophobic interactive, gel filtration, and anion exchange chromatography, as described above. SDS-PAGE under denaturing conditions, and silver staining indicated purification to homogeneity of an Mr=87,000±300 protein subunit (FIG. 2). As summarized in Table 1, analysis of the specific activities at each stage in the purification process indicated that the toxin (CB antigen) was purified more than 5000-fold from the unconcentrated broth culture supernatant and 25-fold from the ammonium sulfate precipitate. Thus, a substantially pure preparation was obtained in which the toxin was present at a concentration, relative to other H. pylori products, higher than that in H. pylori broth culture supernatant. The recovery of the purified toxin was 8 μg per liter of culture supernatant, which represented less than 5% of the toxic activity present in the original unconcentrated supernatant.

In addition to the above discussed purification method, substantially pure toxin can be produced by substituting a SUPEROSE 6 (Pharmacia) column in place of a SUPEROSE 12 (Pharmacia) column. Similarly, other modifications in the purification method, can be employed by one skilled in the art.

                  TABLE 1                                                          ______________________________________                                         Purification of vacuolating cytotoxin activity from                              H. pylori strain 60190                                                         Purification       Specific     Purification                                   step activity.sup.1 (-fold)                                                  ______________________________________                                         Broth culture supernatant                                                                       4.5 ± 1.5 1                                                  Ammonium sulfate precipitate 950 ± 530 211                                  Phenylsuperose chromatography 2000 ± 310  444                               SUPEROSE 12 chromatography 16,000 ± 5900   3556                             MONO Q chromatography 24,000 ± 5600   5333                                ______________________________________                                          .sup.1 The results of three purification are shown (mean ± SEM).            Chromatography conditions were as specified in the text. Specific activit      was defined as the ratio of the reciprocal titer of toxic activity to the      protein concentration (in mg/ml                                          

EXAMPLE 2 Characterization of the CB Protein

After partial purification by hydrophobic interactive and gel filtration chromatography, the toxin preparation was electrophoresed under denaturing conditions on a 7% acrylamide gel. The Mr=87,000 band was excised and eluted from the gel and 0.7M ammonium bicarbonate was added. The solution was then applied to a PHENYLSUPEROSE HR 5/5 column (Pharmacia), and eluted with distilled water. Amino-terminal amino acid sequencing was performed as described previously (Pei, Z., Ellison, R. T., III, Lewis, R. V., and Blaser, M. J. (1988) J. Biol. Chem. 263:6416-6420), and the National Biomedical Research Foundation and Swiss-Prot data bases were searched for potential homologies with known proteins. Amino acid composition analysis was performed as described by Jones (Jones, B. N. (1981) J. Liq. Chromatogr. 4:565:586).

The amino acid composition of the purified, denatured Mr=87,000 protein subunit is as follows (in mole %): Asx 14.8, Glx 9.6, Ser 9.3, His 1.5, Gly 13.0, Thr 6.7, Arg 3.5, Ala 8.1, Tyr 3.8, Met 2.3, Val 6.7, Phe 4.6, Ile 6.7, Leu 9.3 (Lys, Trp, Pro, and Cys not determined). Based on two determinations, the sequence of the 23 N-terminal amino acids is as shown in Table 2 (Sequence Id. No. 1). The N-terminal sequence is rich in hydrophobic amino acids, is uncharged, and has a predicted isoelectric point of 5.83. Garnier-Robson structural predictions indicate that this part of the sequence is associated with a 100% extended conformation.

A comparison between the N-terminal sequence of the Mr=87,000 protein subunit and other known proteins indicated no strong homology. However, there was partial homology between the N-terminus of the Mr=87,000 protein subunit and internal sequences of numerous other known proteins, many of which were involved in transport processes (Table 2) (Salkoff, L., Butler, A., Scavarda, N., and Wei, A. (1987) Nucleic Acids Res. 15:8569-72; Rogart, R. B., Cribbs, L. L., Muglia, L. K., Kephart, D. D., and Kaiser, M. W. (1989) Proc. Natl. Acad. Sci. USA 86:8170-74; Takeyasu, K., Tamkun, M. M., Renaud, K J., and Fambrough, D. M. (1988) J. Biol. Chem. 263:4347-54; Hesse, J. E., Wieczorek, L., Altendorf, K., Reicin, A. S., Dorus, E., and Epstein, W. (1984) Proc. Natl. Acad. Sci. USA 81:4746-50; Mandel, M., Moriyama, Y., Hulmes, J. D., Pan, Y-C. E. Nelson, H., and Nelson, N. (1988) Proc. Natl. Acad. Sci. USA 85:5521-24; Hiles, I. D., Gallagher, M. P., Jamieson, D. J., and Higgins, C. F. (1987) J. Mol. Biol. 195:125-42; and Szkutnicka, K., Tschopp, J. F., Andrews, L., and Crillo, V. P. (1989) J. Bacteriol 171:4486-93; Hawkins, A. R., Lamb, H. K., Smith, M., Keyte, J. W., and Roberts, C. F. (1988) Mol. Gen. Genet. 214:224-231; Goldrick, D., Yu, G.-Q., Jiang, S. Q., and Hong, J.-S. (1988) J. Bacteriol 170:3421-3426). Based on hydropathy plot analyses, the sequences homologous to the H. pylori Mr=87,000 protein subunit were frequently hydrophobic, membrane-spanning segments. In addition to the proteins listed in Table 2, there was partial homology with the calcium channel release protein from pig (Harbitz, I., Chowdhary, B., Thomsen, P. D., Davies, W., Kaufmann, W., Kran, S., Gustavsson, I., Christensen, K., and Hauge, J. G. (1990) Genomics 8:243-248), the kainate gated ion channel precursor from rat (Hollmann, M., O'Shea-Greenfield, A, Rogers, S. W., and Heinemann, S. (1989) Nature 342:643-8), general amino aid permease from Saccharomyces cerevisiae (Jaunizux, J.-C., and Grenson, M. (1990) Eur. J. Biochem. 190:39-44), arginine permease from S. cerevisiae (Hoffmann, W. (1985) J. Biol, Chem. 260:11831-7), lactose permese from E. coli (Buchel, D. E., Groneborn, B., and Muller-Hill, B. (1980) Nature 283:541-545), and the mannose permease EII-P MAN segment from E. coli (Erni, B., Zanolari, B., and Kocher, H. P. (1987) J. Biol. Chem 262:5238-47). The partial homology between the N-terminus of the Mr=87,000 protein subunit and different regions of multiple families of ion channel and transport proteins suggests that this relationship may be significant.

                  TABLE 2                                                          ______________________________________                                         Sequence homology between H. pylori vacuolating                                  toxin and ion channel or transport proteins                                    Start  Sequence                    Finish                                    ______________________________________                                         H. pylori Mr = 87,000 protein subunit                                            1      AFFTT-VI-IPAIVGGIATGTAVGT (SEQ ID NO.1)                                                                    23                                           ***** *: : * * * :: *                                                       Sodium channel: Drosophila                                                       1355   AFFTT-VFGLEAIVKIVGLRYHYFT (SEQ ID NO.2)                                                                    1378                                         **** :* *: ::                                                               Sodium channel protein i cardiac: rat                                            1752   LFFTTYII-ISFLIVVNMYIAIILE (SEQ ID NO.3)                                                                    1775                                         ***:* : : ** :*: *                                                          Na+-K+-transporting-ATPase alpha: chicken                                        241    AFFST-NC-VEGTAVGIVISTGDRT (SEQ ID NO.4)                                                                    263                                          : : **: :**: :::**:                                                         H+-K+-transporting-ATPase b chain: E. coli                                       256    VALLV-CL-IPTTIGGLLSASAVAG (SEQ ID NO.5)                                                                    278                                          : * ** :::** : ::                                                           H+-transporting ATPase proteolipid chain: bovine                                 50     EMIMK-SI-IPVVMAGIIAIYGLVV (SEQ ID NO.6)                                                                    72                                           **: : ** * * **:                                                            Oligopeptide permease: Salmonella typhimuium                                     104    AFLLA-VI-IGVSAGVIAALKQNTR (SEQ ID NO.7)                                                                    126                                          **** * :**                                                                  Galactose permease: Saccharomyces cerevisiae                                     486    AFFTP-FI-TSAINFYYGYVFMGCL (SEQ ID NO.8)                                                                    508                                          **:: :: * :** :                                                             Quinate permease: Aspergillus nidulans                                           458    FFFAS-LM-ILSIVFVFFLIPETKG (SEQ ID NO.9)                                                                    480                                          *::: * ** ::* *:***                                                         Phosphoglycerate transporter: S. typhimurium                                     366    QFLAS-VG-TMEIVPSFAVGSAVGL (SEQ ID NO.10)                                                                   388                                          ***:* : : : *: *: *                                                         Gastric H+-K+-ATPase alpha subunit: human                                        254    AFFST-MC-LEGTAQGLVVNTGDRT (SEQ ID NO.11)                                                                   276                                          * * * : ** : *:*:*                                                          Ca++-ATPase from sarcoplasmic reticulum: rabbit                                  208    LFSGT-NI-AAGKALGIVATTGVST (SEQ ID NO.12)                                                                   230                                          : * ** :::** : ::                                                           Chromaffin granule H+-ATPase 16 kDa proteolipid subunit: bovine                  50     EMIMK-SI-IPVVMAGIIAIYGLVV (SEQ ID NO.13)                                                                   72                                        ______________________________________                                          *indicates identity with H. pylori Mr+87,000 protein subunit                   :indicates conservative substitutions                                    

Determination of the molecular mass of the non-denatured toxin (CB antigen) was performed on a SUPEROSE 6 HR 10/30 column (Pharmacia) with buffer containing 60 mM Tris-HCl and 0.1M NaCl (pH 7.7). Standards (Sigma, St. Louis, Mo.) included salmon sperm DNA (void volume), blue dextran (2,000,000), bovine thyroglobulin (669,000), horse spleen apoferritin (443,000), beta-amylase from sweet potato (200,000), bovine serum albumin (66,000), and carbonic anhydrase from bovine erythrocytes (29,000). The toxin preparation used in this analysis was partially purified by hydrophobic interactive and gel filtration chromatography, and then applied to the SUPEROSE (Pharmacia) 6 HR 10/30 column. Vacuolating toxin activity, as detected in cell culture, as well as the Mr=87,000 band detected by SDS-PAGE, were present in several fractions, each with an Mr greater than 972,000, suggesting aggregation. To determine whether aggregation resulted from processes used in the purification, unconcentrated broth culture supernatant from H. pylori 60190 was passaged through the same column, and fractions were analyzed in an ELISA for reactivity with antiserum to the Mr=87,000 protein subunit. Multiple fractions containing proteins with calculated molecular weights greater than 100,000 were recognized by the antiserum, an indication that aggregation of the Mr=87,000 protein subunit also occurred in unprocessed supernatant.

The pI of the purified toxin was determined by isoelectric focusing. Isoelectric focusing was performed on a Resolve Alpha horizontal electrophoresis unit (Isolab, Inc., Akron, Ohio) using a 5% acrylamide gel (LKB, Bromma, Sweden) containing 5M urea and 2.5% ampholytes (pH range 3.5-9.5). Standards (Sigma) were trypsin inhibitor (4.6), beta-lactoglobulin A (5.13), bovine carbonic anhydrase II (B) (5.9), and human carbonic anhydrase B (6.6). The purified denatured H. pylori Mr=87,000 protein subunit and isoelectric focusing standards were transferred to nitrocellulose paper by electroblotting for one hour. The standards were resolved by staining with Coomasie blue, and the H. pylori protein was resolved by immunoblotting with specific antiserum, using the methods described below. The non-denatured toxin failed to migrate in a 1% agarose gel (Isolab, Akron, Ohio), presumably due to its large size, Therefore, the Mr=87,000 protein subunit was eluted from an SDS-PAGE gel fragment, and focusing in a 5% acrylamide gel containing 5M urea indicated a pI of approximately 6.1.

EXAMPLE 3 Use of Specific Antiserum to the Toxin in Detection and Neutralization of the CB Antigen

Antiserum to the Mr=87,000 protein subunit was raised in a female White New Zealand rabbit, according to the regimen described previously (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610). Initially, the rabbit was immunized with Coomasie blue-stained acrylamide gel fragments containing the denatured Mr=87,000 protein subunit. Subsequently, the rabbit was immunized with the denatured Mr=87,000 protein subunit that was eluted in distilled water from unstained SDS-PAGE gels, and concentrated by hydrophobic interactive chromatography as described above.

Preimmune and immune serum were assessed by Western blot analysis. Following separation by SDS-PAGE, proteins in H. pylori culture supernatant were transferred to nitrocellulose paper by electroblotting for one hour at one amp. Nitrocellulose paper strips were incubated with sera, washed, incubated with alkaline phosphatase-conjugated anti-human IgG (Boehringer-Mannheim, Indianapolis, Ind.) or anti-rabbit IgG (Tago, Burlingame, Calif.), and developed as described by Blake et al. (Blake, M. S., Johnston, K. H., Russel-Jones, G. I., and Gotschlich., E. C. (1984) Anal. Biochem. 136:175-179). Antiserum raised against the purified Mr=87,000 protein subunit recognized the Mr=87,000 protein band and no other H. pylori constituents (FIG. 3).

Preimmune and immune rabbit sera were also assessed by ELISA. The ELISA was performed with 15 ng purified CB antigen per microtiter well, and the methodology was as previously described (Perez-Perez, G. I., Dworkin, B. M., Chodos, J. E., and Blaser, M. J. (1988) Ann. Intern. Med. 109:465-471 hereby incorporated by reference). Peroxidase-conjugated anti-human IgG (Tago) or anti-rabbit IgG (Boehringer Mannheim) were used as the conjugates. The titer of rabbit serum was defined as the reciprocal of the highest dilution that produced an optical density of greater than 0.2. Using this methodology, the titer of the antiserum was 1:512,000, whereas that of the preimmune serum was <1:200.

Neutralization of Vacuolating Toxic Activity.

The toxin preparation used in neutralization assays was prepared by culturing H. pylori 60190 for 48 hours in Brucella broth containing 5% fetal bovine serum, centrifuging the culture, and concentrating the supernatant by ultrafiltration, as previously described (Cover, T. L., Puryear, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). Sera were heated at 56° C. for 30 minutes, diluted in tissue culture medium, and incubated for one hour with an equal volume of concentrated H. pylori supernatant, as previously described (Cover, T. L., Cao,P., and Blaser, M. J. (1991) Gastroenterology 100:A570). The neutralizing effects of sera on the vacuolating toxic activity were quantitated using the neutral red uptake assay (Cover, T. L., Puryear, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). Under the assay conditions used, at a 1:64 dilution the antiserum completely neutralized vacuolating toxin activity in supernatant from H. pylori 60190, whereas preimmune serum lacked neutralizing activity (FIG. 4). The antiserum also completely neutralized the toxin activity present in culture supernatants from two other toxin-producing H. pylori strains, an indication that the vacuolating toxins produced by various H. pylori isolates are antigenically related.

                  TABLE 3                                                          ______________________________________                                         H. pylori isolates from humans used in the study                                                        Toxin  Reciprocal toxin                                 Strain Source production titer.sup.a                                         ______________________________________                                         60190    ATCC 49503  +        320                                                85-456 NTCC 11638 + 40                                                         87-29 Colorado + 160                                                           87-199 Colorado + 80                                                           87-81 Colorado + 40                                                            87-90 Colorado + 40                                                            86-86 New York + 80                                                            88-43 Thailand + 20                                                            Tx30a Texas - <10                                                              87-141 Colorado - <10                                                          87-75 Colorado - <10                                                           86-385 Colorado - <10                                                          86-313 Colorado - <10                                                          87-6 Colorado - <10                                                            87-225 Colorado - <10                                                          87-203 Colorado - <10                                                        ______________________________________                                          .sup.a The reciprocal toxin titer was defined as the greatest dilution         that induced HeLa cell neutral red uptake greater than 3 SD above that         induced by medium alone, as described (Cover, T. L., Puryear, W.,              Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270)

Detection of the Vacuolating Toxin in H. pylori Culture Supernatants.

The next experiment was designed to determine whether there was a relationship between vacuolating toxin activity and presence of the CB antigen in H. pylori culture supernatants. From a collection of concentrated H. pylori culture supernatants, we selected supernatants from 8 tox⁺ and 8 tox⁻ strains (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610).

These H. pylori strains (Table 2) were cultured in Brucella broth containing 5% fetal bovine serum, and the culture supernatants were concentrated by ultrafiltration as previously described (Cover, T. L., Dooley, C. P., and Blaser, M. J. (1990) Infect. Immun. 58:603-610).

To quantitate vacuolating toxin activity, dilutions of each of these supernatants were tested using the neutral red assay (Cover, T. L., Puryear, W., Perez-Perez, G. I., and Blaser, M. J. (1991) Infect. Immun. 59:1264-1270). Diluted greater than 1:20, each of the tox⁺ supernatants induced greater than two-fold greater net neutral red uptake by cells than medium alone, whereas each of the tox⁻ supernatants failed to induce significant neutral red uptake when diluted 1:10. To detect the CB antigen, the 16 supernatants were tested by ELISA with a 1:10,000 dilution of antiserum to the Mr=87,000 protein subunit (FIG. 5). The supernatants from tox⁺ strains produced significantly higher optical density values than supernatants from tox⁻ supernatants (0.614±0.105 versus 0.046±0.009, p <0.0001). Western blotting studies confirmed the presence of the Mr=87,000 band in each of the tox⁺ supernatants, indicating that this is the form of CB antigen under denatured conditions. The lack of overlap between these two groups of supernatants indicates that the CB antigen is the major substituent in H. pylori supernatants that mediates vacuolating toxin activity.

EXAMPLE 4 Detection of Anti-toxin Antibodies in Body Fluids from H. pylori-infected Humans.

Previous studies have demonstrated that sera from some, but not all H. pylori-infected persons contain toxin-neutralizing antibodies (Leunk, R. D., Ferguson, M. A., Morgan, D. R., Low, D. E., and Simor, A. E. (1990) J. Clin. Microbiol. 28:1181-1184; Cover, T. L., Cao,P., and Blaser, M. J. (1991) Gastroenterology 100:A570). We therefore sought to determine the prevalence of antibodies to the purified CB antigen protein in sera from H. pylori-infected and uninfected humans.

Human sera were obtained from forty selected symptomatic patients who had previously undergone gastroduodenal endoscopy at the University Hospital and the Veterans Administration Medical Center, Syracuse, N.Y. Based on analysis of the gastric biopsy specimens and serologic evaluation of these patients, 20 were infected with H. pylori and twenty were uninfected. The characteristics of these patients and the toxin-neutralizing activities of these sera have been previously described (Cover, T. L., Cao,P., and Blaser, M. J. (1991) Gastroenterology 100:A570). These 40 sera were tested for IgG reactivity with the purified CB antigen in an ELISA (FIG. 6).

The ELISA was performed with 15 ng purified CB antigen per microtiter well, and the methodology was as previously described (Perez-Perez, G. I., Dworkin, B. M., Chodos, J. E., and Blaser, M. J. (1988) Ann. Intern. Med. 109:465-471 hereby incorporated by reference). Peroxidase-conjugated anti-human IgG (Tago) or anti-rabbit IgG (Boehringer Mannheim) were used as the conjugates. The mean recognition of the CB antigen by sera from H. pylori-infected persons was significantly stronger than by sera from uninfected persons (p=0.0009). Sera from approximately half of the H. pylori-infected persons produced optical density values that overlapped those of uninfected persons, whereas sera from other H. pylori-infected persons produced optical density values that did not overlap. This suggests that two populations may be present, and is consistent with the observation that 50%-60% of H. pylori strains are toxigenic in vitro. We then determined whether there was a relationship between recognition of the CB antigen by ELISA and toxin-neutralizing activity, as determined previously in the cell culture assay (Cover, T. L., Cao,P., and Blaser, M. J. (1991) Gastroenterology 100:A570). For sera from H. pylori-infected persons, ELISA recognition of the CB antigen was significantly associated with toxin-neutralizing activity (p=0.019, r=0.518 by linear regression analysis). In contrast, for sera from uninfected persons, these variables were not significantly associated (p=0.973, r=0.008).

EXAMPLE 5 Preparation of an Oral Vaccine for Administration to Mammals Including Humans

We have considered the potential application of the use of the CB protein in the development of a vaccine against H. pylori infections. To limit the effects of gastric acid and proteolytic enzymes on the vaccine preparation, the whole CB protein will be packaged either in an enteric coated gelatin capsule or administered with sodium bicarbonate (Black et al, "Immunogenicity of Ty21a attenuated Salmonella typhi given with sodium bicarbonate or in enteric-coated capsules." Dev. Biol. Stand. 53:0, 1983). Dosage for adult humans preferably varies from 5.0-50.0 mg of the antigens of the invention.

To enhance delivery of CB protein to the gastrointestinal immune system the protein [or a fragment(s) of the protein] may be incorporated without chemical coupling into biodegradable microspheres that are 5-10 μm in size that will be ingested orally (Eldridge et al., "Biodegradable microsphere: vaccine delivery systems for oral immunization," Curr. Top. Microbiol. Immunol. 146:59, 1989). The microspheres are composed of co-polymers of glycolic and lactic acids which are degraded into original components by hydrolysis. Adjusting the ratio of glycolic to lactic acids within the co-polymers varies the rate of hydrolysis from several hours to several months. Thus, both fast- and slow-releasing microspheres can be created. The use of a mixture of both fast- and slow-releasing microspheres will then be used to allow for induction of both a primary and secondary immune response with a single oral immunization.

EXAMPLE 6 Preparation of a Parenteral Vaccine for Administration to Mammals Including Humans

Although for gastrointestinal pathogens, orally administered vaccines appear to be preferable, for several other infectious agents, parenteral vaccine show efficacy. A component of the bacterium Salmonella typhi, the cause of typhoid fever, has been purified and used as a parenteral-administered vaccine. This component, the Vi capsular polysaccharide, is highly efficacious (Klugman KP, et al. Protective activity of Vi capsular polysaccharide vaccine against typhoid fever, "Lancet 1987;2:165-69"). The Salk vaccine for polio is administered parenterally and it prevents the disease of polio, although having little or no effect on becoming infected with the polioviruses. Parenteral vaccines also have efficacy, although limited, in preventing cholera.

For H. pylori, a parenteral vaccine could include CB protein or fragments thereof. A toxoid preparation could also be prepared, analogous to the use of diphteria or tetanus toxoids. The protein(s) or fragment(s) could be administered with an adjuvant or by itself in a suitable buffer. Reasonable adjuvants include, but are not limited to, muramyl dipeptide, concanavalin A, DEAE dextran, lipid polyvalent cations, or hydrocarbons such as hexadecane.

H. pylori vaccine could be given to humans as 1.0 mg (range 0.5-5.0 mg) of antigen (CB protein) in 1 ml of phosphate buffered saline (pH 7.4). With a suitable antigen, only a single dose may be needed, but multiple doses with or without adjuvants could be considered.

EXAMPLE 7 Test Kits for Detection of Antibodies to H. pylori Toxin, and for Detection of H. pylori Toxin

Specific test kits are constructed for detecting antibodies using several different techniques for detection. One test kit for antibody detection is comprised of a compartmented enclosure containing a plurality of wells, plates which were coated prior to use with CB protein or an antigenic fragment thereof, and ELISA materials for enzyme detection consisting of peroxidase-labeled goat anti-human IgG and a color change indicator consisting of ABTS in McIlvain's buffer with 0.005 percent hydrogen peroxide. Naturally, other enzymes and developers could have been used. For instance, alkaline phosphatase-labeled goat anti-human IgG could be used in conjunction with p-nitrophenyl phosphate in diethanolamine and magnesium chloride buffer.

A second test kit for detecting antibodies using the Western blot technique is comprised of a container, cover, nitrocellulose sheet, and a polyacrylamide slab gel in the presence of sodium dodecyl sulfate, surfactants, pH modifiers, dried nonfat milk and materials for enzyme detection including a color change indicator consisting of DAB in Tris with hydrogen peroxide. This Western blot analysis kit also contains peroxidase-labeled goat or rabbit anti-human immunoglobulin and a source of CB protein or antigenic fragment thereof.

Another H. pylori specific test kit for detecting antibodies using the indirect immunofluorescence assay may include a compartmental container with CB protein or antigenic fragments thereof as antigens, human test serum, phosphate buffered saline and fluorescein-conjugated goat anti-human IgG.

Finally, a different H. pylori specific test kit for detecting antibodies uses liposomes and comprises a container, human test serum, fluorescent marker- (or enzyme- or substrate-) filled liposomes with antigens on their surface, and a surface-active agent. In this assay the container might be a precoated tube or well with goat anti-human IgG.

H. pylori specific test kits are constructed for detecting H. pylori toxins using several different techniques for detection. One test kit for detection of H. pylori toxin comprises a compartmented enclosure containing a plurality of wells, plates that could be coated with the sample to be tested, a hyperimmune antiserum (or monoclonal antibodies) to CB protein or antigenic fragment thereof, anti-rabbit immunoglobulin and appropriate ELISA materials such as those discussed above in this example.

A second test kit for detecting H. pylori toxin using the Western blot technique is comprised of a container, cover, nitrocellulose sheet, and a polyacrylamide slab gel in the presence of sodium dodecyl sulfate, surfactants, pH modifiers, dried nonfat milk and materials for enzyme detection including a color change indicator consisting of DAB in Tris with hydrogen peroxide. This Western blot analysis kit also contains goat anti-rabbit immunoglobulin and a source of hyperimmune antiserum to CB protein or antigenic fragment thereof.

Another H. pylori specific test kit for detecting the toxin using the latex agglutination assay may include a compartmental container, hyperimmune serum to CB protein or antigenic fragment thereof conjugated to latex beads, and phosphate buffered saline or water.

Although the invention has been described primarily in connection with special and preferred embodiments, it will be understood that it is capable of modification without departing from the scope of the invention. The following claims are intended to cover all variations, uses, or adaptations of the invention, following, in general, the principles thereof and including such departures from the present disclosure as come within known or customary practice in the field to which the invention pertains, or as are obvious to persons skilled in the field.

    __________________________________________________________________________     #             SEQUENCE LISTING                                                    - -  - - <160> NUMBER OF SEQ ID NOS: 13                                        - - <210> SEQ ID NO 1                                                         <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =              synthetic construct                                                       - - <400> SEQUENCE: 1                                                          - - Ala Phe Phe Thr Thr Val Ile Ile Pro Ala Il - #e Val Gly Gly Ile Ala        1               5  - #                10  - #                15                - - Thr Gly Thr Ala Val Gly Thr                                                           20                                                                  - -  - - <210> SEQ ID NO 2                                                    <211> LENGTH: 24                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 2                                                          - - Ala Phe Phe Thr Thr Val Phe Gly Leu Glu Al - #a Ile Val Lys Ile Val        1               5  - #                10  - #                15                - - Gly Leu Arg Tyr His Tyr Phe Thr                                                       20                                                                  - -  - - <210> SEQ ID NO 3                                                    <211> LENGTH: 24                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 3                                                          - - Leu Phe Phe Thr Thr Tyr Ile Ile Ile Ser Ph - #e Leu Ile Val Val Asn        1               5  - #                10  - #                15                - - Met Tyr Ile Ala Ile Ile Leu Glu                                                       20                                                                  - -  - - <210> SEQ ID NO 4                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 4                                                          - - Ala Phe Phe Ser Thr Asn Cys Val Glu Gly Th - #r Ala Val Gly Ile Val        1               5  - #                10  - #                15                - - Ile Ser Thr Gly Asp Arg Thr                                                           20                                                                  - -  - - <210> SEQ ID NO 5                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 5                                                          - - Val Ala Leu Leu Val Cys Leu Ile Pro Thr Th - #r Ile Gly Gly Leu Leu        1               5  - #                10  - #                15                - - Ser Ala Ser Ala Val Ala Gly                                                           20                                                                  - -  - - <210> SEQ ID NO 6                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 6                                                          - - Glu Met Ile Met Lys Ser Ile Ile Pro Val Va - #l Met Ala Gly Ile Ile        1               5  - #                10  - #                15                - - Ala Ile Tyr Gly Leu Val Val                                                           20                                                                  - -  - - <210> SEQ ID NO 7                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 7                                                          - - Ala Phe Leu Leu Ala Val Ile Ile Gly Val Se - #r Ala Gly Val Ile Ala        1               5  - #                10  - #                15                - - Ala Leu Lys Gln Asn Thr Arg                                                           20                                                                  - -  - - <210> SEQ ID NO 8                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 8                                                          - - Ala Phe Phe Thr Pro Phe Ile Thr Ser Ala Il - #e Asn Phe Tyr Tyr Gly        1               5  - #                10  - #                15                - - Tyr Val Phe Met Gly Cys Leu                                                           20                                                                  - -  - - <210> SEQ ID NO 9                                                    <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 9                                                          - - Phe Phe Phe Ala Ser Leu Met Ile Leu Ser Il - #e Val Phe Val Phe Phe        1               5  - #                10  - #                15                - - Leu Ile Pro Glu Thr Lys Gly                                                           20                                                                  - -  - - <210> SEQ ID NO 10                                                   <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 10                                                         - - Gln Phe Leu Ala Ser Val Gln Thr Met Glu Il - #e Val Pro Ser Phe Ala        1               5  - #                10  - #                15                - - Val Gly Ser Ala Val Gly Leu                                                           20                                                                  - -  - - <210> SEQ ID NO 11                                                   <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 11                                                         - - Ala Phe Phe Ser Thr Met Cys Leu Glu Gly Th - #r Ala Gln Gly Leu Val        1               5  - #                10  - #                15                - - Val Asn Thr Gly Asp Arg Thr                                                           20                                                                  - -  - - <210> SEQ ID NO 12                                                   <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 12                                                         - - Leu Phe Ser Gly Thr Asn Ile Ala Ala Gly Ly - #s Ala Leu Gly Ile Val        1               5  - #                10  - #                15                - - Ala Thr Thr Gly Val Ser Thr                                                           20                                                                  - -  - - <210> SEQ ID NO 13                                                   <211> LENGTH: 23                                                               <212> TYPE: PRT                                                                <213> ORGANISM: Artificial Sequence                                            <220> FEATURE:                                                                 <223> OTHER INFORMATION: Description of Artificial - #Sequence:/Note =               synthetic construct                                                       - - <400> SEQUENCE: 13                                                         - - Glu Met Ile Met Lys Ser Ile Ile Pro Val Va - #l Met Ala Gly Ile Ile        1               5  - #                10  - #                15                - - Ala Ile Tyr Gly Leu Val Val                                                           20                                                                __________________________________________________________________________ 

We claim:
 1. A diagnostic test kit for detecting H. pylori infection said test kit comprising:a) an immobilized antigenic composition comprising purified, non-denatured H. pylori vacuolating toxin having a molecular weight of approximately 972,000 purified to at least 5000 fold greater specific activity compared to broth culture supernatant; b) means for passing bodily fluids taken from a human or animal to be tested over said immobilized antigenic composition; and c) means for detecting immunoglobulin, the presence of said immunoglobulin being associated with H. pylori infection.
 2. A method to detect antibodies against H. pylori vacuolating toxin in a sample of bodily fluid taken from a human or animal comprising:a) contacting purified, non-denatured H. pylori vacuolating toxin having a molecular weight of approximately 972,000, purified to at least 5000 fold greater specific activity compared to broth culture supernatant, bound to a solid phase with said sample; b) incubating said contactants of Step a) to allow specific bonding of said antibodies against H. pylori vacuolating toxin to said bound purified vacuolating toxin; and c) detecting said bound antibodies.
 3. A method of detecting infection caused by a toxin-producing H. pylori strain in a patient comprising:a) contacting purified, non-denatured H. pylori vacuolating toxin having a molecular weight of approximately 972,000, purified to at least 5000 fold greater specific activity compared to broth culture supernatant, bound to a solid phase with an antibody-containing sample of bodily fluid from said patient; b) incubating said contactants of Step a) to allow specific bonding of said antibodies to said bound purified vacuolating toxin; and c) detecting said bound antibodies, the presence of said antibodies being associated with infection by a toxin-producing H. pylori strain.
 4. A method to detect antibodies against H. pylori vacuolating toxin in a patient and thereby to determine the susceptibility of a patient to develop peptic ulcer disease, gastric carcinoma or other clinical consequences of H. pylori infection comprising:a) contacting the purified, non-denatured H. pylori vacuolating toxin having a molecular weight of approximately 972,000, purified to at least 5000 fold greater specific activity compared to broth culture supernatant, bound to a solid phase with an antibody-containing sample of bodily fluid from said patient; b) incubating said contactants of Step a) to allow specific bonding of said antibodies to said bound purified vacuolating toxin; c) detecting said bound antibodies, the presence of said antibodies being associated with an increased risk of a patient to develop peptic ulcer disease, gastric carcinoma or other clinical consequence of H. pylori infection. 